t breakneck speed and despite its immense complexity, Lansley's Health & Social Care bill has been railroad- ed through the Commons although the LibDems and out- side pressure did lead to an almost unprecedented pause in its progress. An unelected group, the Future Forum led by the previous Chair of the Royal College of General Practictioner's Steve Field who had welcomed the White Paper - misleadingly called Equity and Excellence: Liberating the NHS, had 6 weeks to listen to the public and the 45 members met with 6,700 people. Sounds impressive but how were people selected and did you know about these consultations? Its only 0.01% of the adult population of England, and why the rush? Compare this reaction to that of laid back banking reform suggested by the Bank of International Settlements (BIS) delayed implementation until 2019. Ministers prepared a report, which was spun to suggest complete agreement by the government, which did make some minor changes to the Bill. But changing 'promoting competition' to ensuring no 'anti-competitive behaviour' is hardly radical.
Afterwards Andrew Lansley told Tory backbenchers that 'no red lines have been crossed'. A second bill committee was immediately set up, they finished on 14th July and the amended bill was printed on the day Parliament was due to rise for the summer recess on 19th July. Parliament resumed on 5th September and the third reading and report stage were held on 6th and 7th of that month. The Bill passed with a majority of 65 and disappointingly only four Lib Dem MPs voted against: Andrew George, who had tried to get the bill opposed in the LibDem Spring conference, Julian Huppert, Greg Mulholland, and Adrian Sanders. The Bill was read for the first time in the Lords on 8th September and the second reading was on 11th and 12th of October.
Thanks to the TUC's 'Adopt a Lord initiative' which was followed by 38 degrees, and lobbying by others, there was no doubt that the Lords realized this was a contentious issue and 100 Lords spoke in the second reading debate which sat till 12.23am on the first day and ran on to a second day. Lord Rea's amendment 'to decline to give the bill a second reading' fell by 134 votes (220 for and 354 against). This would have stopped the Bill in its tracks. Lords Owen and Hennessy's amendment, for a select committee to look at parts of the bill in detail fell by 68 votes (262 for and 330 against). The committee stage started on 25th October and 14 days were set aside for the 360 amendments to be discussed in the committee stage on the floor of the house. The prime minister and his government are keen to preach democratic principles to other countries, yet the way this bill has been managed is anything but democratic.
Before the election David Cameron said his priorities were 'NHS, NHS, NHS' and that there would be 'no top down re-organisation' and the electorate believed him in part because unusually he had had experience of NHS care for his disabled son. How wrong we were. During PMQs on 16 March, David Cameron denied that this Bill amounted to wholesale reorganisation. 'We are not reorganising', he said, 'We are abolishing SHAs and PCTs'. What sophistry. The Coalition agreement did not suggest that there was to be this radical re-organisation of the NHS and specifically mentions the role of Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) in implementing the unprecedented 'efficiency savings' which had been planned before the election. This Bill is designed to turn the NHS into a market, despite evidence that healthcare is unsuitable for market mechanisms and despite the strenuous assertions by Cameron and Lansley that there will not be any privatisation. Although not unexpected, voting in the House of Lords was a big disappointment.
The lack of media interest compounded that feeling. Only two Lib Dem peers: Baroness Jenny Tonge, a former family planning doctor and manager of community services, and Lord Greaves, voted in support of Lord Rea's amendment and only a handful of crossbench peers, one Labour peer Lord Warner voted against. So, this flawed, unnecessary and complicated Bill ploughs on. However, all is not lost. On the 14th November the Lords passed an amendment about VAT and charities by 46 against government wishes. The fight is not yet over and we must continue to apply pressure on members of the Lords to make sure that significant amendments are made in order to reduce the damage this bill will otherwise do. We must also continue to challenge and inform Liberal Democrat and marginal Tory MPs because they have to agree to any changes the Lords make when the Bill comes back to the Commons. Tim Tregherz a public interest lawyer has done a detailed briefing about the process in the Lords and Allyson Pollock and David Price are working on detailed amendments.
What you can do now is this:
- Look at our website www.keepournhspublic.com
- Join KONP and join your local group and take part in marches, demonstrations or other public events which keep the issues on the agenda. If you learn that Andrew Lansley is appearing in your area, spread the word and let us know so a suitable 'welcome' can be arranged. A Question Time picket was arranged by Lewisham KONP at 24 hours notice and made a big impact.
- Go and see your LibDem MP and make it clear that if the Bill goes through without significant amendments you will never vote LibDem (again).
- Continue the dialogue with your allocated peer and ask her/him to support amendments which retain the responsibility of the Secretary of State to provide a comprehensive health service –this amendment was not voted on and government will amend and bring it back at report stage.
- Ensure the NHS is the normal provider of services
- Limit the role of Monitor as a market regulator, insist on collaboration
- Ensure that commissioning is done by NHS staff not private companies
- Ensure that commissioning groups are co-terminous with local authorities to facilitate collaborative social as well as health care
- Ban commercial confidentiality in any contract using taxpayers money
- Strengthen the rights of Health and Well Being Boards
- Ensure registration with the CQC is only required for new entrants into the market not all NHS hospitals, dentists and GPs
- Ensure that Board meetings are in public with published minutes for all commissioning groups and the National Commissioning Board
- Keep a cap on private practice income in Foundation Trusts.
There are many other areas where amendments need to be made and the plans for education and training are scheduled for a consultation in early 2012. Discussion about the social care aspects of the Bill and HealthWatch have been infrequent despite their importance. The process of scrutinising the bill 'line by line' is not really appropriate for dealing with this Bill which needs to be seen as a whole, but unless we can get it withdrawn by outside pressure, this is what we have to do.
Remember as Aneurin Bevan said of the NHS: “It will survive as long as there are folk left with the faith to fight for it”. We must continue to fight and get others to join us because the people of England do not want the NHS turned into a market.
See the debate on www.parliamentlive.tv
Professor Wendy Savage is a retired NHS consultant gynaecologist and co-chair of Keep Our NHS Public (KONP)
Chartist 254 January/February 2012